Submission Form

Complete this form and return it with your submission by June 02, 2008.
Only one submission per student.

I. AUTHOR IDENTIFICATION

Students's Name - First: Last:
Student's age:
Parent/Guardian's Name - First: Last:
Student's Address:City:
Zip code:County:
Phone: Fax:
Student's email:
Parent's email:
Teacher's Name - First: Last:
School Name:
Department Name:
School's Address:City:
Zip code:County:
Phone: Fax:
Teacher's email: Web address:

II. QUESTIONAIRE

How did your teacher hear about this?

Direct mail
E-mail
CAC website
County Arts Council
Other (Please specify)

III. STORY INFORMATION

Title of Story:
Date written:    Click Here to Pick up the date
Artist's Statement (Describe your inspiration for the experience captured in your story):


IV. REGISTRATION

Upon submission of this form, you must print and sign the release form which will be displayed. YOU MUST SIGN AND SUBMIT THE RELEASE FORM, along with your parent or guardian, or you will not be elgible for Story Slam.

Please enter the following names as they will appear on the release form:

Student's name:
Parent/Guardian Name:
relation to Student:

V. CHECKLIST

REQUIREMENT
Check when
Completed
Write your name and title of the work on all pieces of your entry for identification purposes?
Include an English translation copy with a submission written in a language other than English?